There are five pillars that any diabetic needs to be successful and fortunately, those four are easy to remember because they form a 5-letter acronym: DIETS: Diet, Insulin, Exercise, Technology, and Sleep.

The interesting thing about those four is that they are interrelated results of healthy habits. Emergent research supports the idea that developing healthy habits improves behaviors and outcomes when designs are gamified.

From fasting to feasting, insulin to exercise, and technology to sleep, each of these five pillars form a strategy to diabete that, when optimized, produces optimal HbA1c results.

  1. D
    1. Diet
      1. Fasting is an important part of the cycle.
      2. Feasting (or refeeding) is also an important part of the cycle.
        1. A note of caution: I mention refeeding because fasting too long followed by eating too much, too fast, too soon can be fatal.
      3. The weekly feeding cycle is personal.
      4. Similarly, the daily feeding cycle is personal.
      5. My daily feeding scheme works best between Noon and 6 PM.
      6. My weekly feeding scheme works best on a cadence like MTWTFSS, where bold MWF means feast and normal TTSS means fast Tuesday, Thursday, Saturday, and Sunday.
      7. I did 3 day fasts once a month or so over the last 15 years but fell back to this more conservative protocol since euglycemic ketoacidosis was challenging to prevent on the longer fasts given my low carbohydrate intake and slow running long distances from 10K to 10M per day.
      8. I'm a fan of food rules by Michael Pollan. Eat whole foods, mostly plants.
      9. Speaking of whole foods, this doesn't need to be expensive. You can find vegan baby food at Aldi that is delicious and nutritious for less than a dollar per 20 grams of carbohydrate. I carry these running to treat hypoglycemia.
      10. I've eaten a range of diets over the years from omnivore to vegan, ketogenic to vegetarian, and everything in between.
      11. Having that experience, I can say this: all else being equal, the best combination of satiety, sports performance, and satiety arises when I eat vegetarian. And yes, I've read everyone from Colin Campbell to Neil Barnard and I'm well aware of the research.
  2. I
    1. Insulin
      1. Prefer the fastest acting human synthetic you can afford.
      2. I use hybrid, closed-loop insulin pump: the Tandem t:slim X2 paired with a Dexcom G6 CGM.
      3. The best HbA1c numbers I've seen from T1D are from people using emergent research combinations of insulin and T2D drugs such as metformin, sitagliptin, or the like. In the United States that seems more likely when the T1D is also an MD since it may be difficult to get a prescription for these drugs off-label.
  3. E

    1. Exercise
    2. My focus is mostly aroebic. I should probably consider anaerobic exercise since I'm so weak.
    3. My exercise of choice is cycling.
    4. I also enjoy rowing.
    5. I settle for running because it is more efficient in terms of time/effect ratio.
  4. T

    1. Technology
    2. I'll fill in more detail here as I find time, but for now, see my write-ups here:
      1. Tandem tslim:X2
      2. Dexcom G6
  5. S
    1. Sleep
    2. My recommendation here is to sleep daily as much as possible.
    3. I am lucky in that I enter deep sleep on a steep curve and rest easily in short naps.
    4. However, as I've grown older, I have more sleeplessness, and have found that a simple OTC gummy consisting of melatonin, L-theanine, and magnesium helps sleep quality if not quantity.